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Last rites of a GP trainer

Peverley is horrified by the transformation of GP training from mentoring system to e-labyrinth

You join me at an epochal moment in my professional life. I'm a little loaded with emotion, if I'm perfectly honest.

It's 11pm on a Tuesday night. In an hour, I'll lose a part of my identity. For the past ten years or so, I've been a GP Trainer. And at midnight, I won't be a trainer any more.

I think we all know the value of a good GP trainer (not that I'm putting myself into that category). Almost everyone reading this will have had the benefit of two GP mentors who have guided them through the Byzantine labyrinth of primary care, signposting the mysteries of social and family medicine, the wonders of the placebo and ‘the doctor as drug', and the invaluable resource of ‘time as a tool'.

I myself at this late stage would like to publically doff my cap to two extraordinary professionals, Dr Mike Wood and Dr Paul Milne. The former taught me how to be a GP and the latter taught me how to pass the MRCGP; two areas of expertise that, at the time, and to a certain extent even now, I judged mutually exclusive. Peace and long life to you both, gentlemen, and I haven't forgotten. Through your own selfless commitment and enthusiasm, you gifted me a love and an appreciation of what I do for a living. You showed me what we can do for our patients. And you made me want to pass the gift on.

However, I can't, now. The first I knew about it was an email from the VTS (Vocational Training Scheme) saying in effect ‘We are sorry you do not wish to continue to be a GP trainer…' followed immediately by an email from my last registrar saying ‘What the feck? Are you mad?'

I made further enquiries and it turned out that I had failed to reply to some email or other asking if I wished to re-apply to be on the trainers' register. I've never had to re-apply before. I replied and told them that in fact I DID wish to remain a trainer, but apparently it's all too late and although I can re-apply for next year if I want, nothing is guaranteed.

Well, sitting here at this moment in one of those rare long dark teatimes of the soul, I'm not sure if I'm going to bother re-applying. And this is why.

Those of you who aren't trainers or registrars will have no conception of how GP training has changed over the last few years. A relatively benign paper-light mentoring system has changed beyond recognition into an electronic hell of endless online recording, assessment and re-assessment. The RCGP eportfolio might have started life as a potentially handy way of recording your experiences as a GP registrar online, but it has rapidly descended into a maelstrom of eternal meaningless repetition and drudgery.

Every clinical procedure has to be witnessed, recorded and graded. I have to watch my registrars perform the most perfunctory actions, such as breast examination or PR exam or subcutaneous injection, and grade them on it. These are qualified doctors. It's demeaning. The training process has been reduced from a learning experience to an endless polishing of a huge online CV detailing every bloody clinical encounter, and their ‘reflective' thoughts thereon, which will never be read by anybody, and which means nothing.

As a trainer, I've been burdened by the new, unasked-for and even now unexplained role of ‘educational supervisor', which seems to involve mentoring the education of a couple of extra registrars as they wend their way through the maze. I have meetings with them every few months that take hours of my time, and involve hours of head-scratching in front of illogical slow-loading computer screens that drive both of us to distraction. My last two of these meetings have ended in the eportfolio website crashing and losing hours of work, hours of my and my registrars time, and making me genuinely wish to torture and kill the architects of such miserable bureaucratic crap.

And there's more; for the privilege of being a GP trainer I have to undergo an EXTRA annual appraisal on top of the other one, this one more stringent and involving things like compulsory attendance at equality and diversity update sessions that I am just, frankly, not prepared to do. I'm not a child, for Christ's sake.

There's been no suggestion of any more money for all this endless extra pointless garbage, but this doesn't surprise me. No-one trains for the money. There isn't any, in real terms. But there comes a point where one must say thus far, and no further.

I suspect that this may well turn out to be my suicide note as far as further training is concerned, but you know what? I no longer care. I wanted to train GPs and pass on what expertise and enthusiasm I've got, but everyone has their limits and I've reached mine. Here's my message to the RCGP; think again. Think hard and think fast. And find someone else. I'm not the only trainer thinking along these lines, as you'll no doubt soon discover.

Dr Phil Peverley is a GP in Sunderland.

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